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"Diagnosis-Independent Alzheimer Disease Biomarker Signature in Cognitively Normal Elderly People"

I heard Trojanowski (the senior author) talk about this last month at the annual meeting of the American Association for Clinical Chemistry. It's a very interesting topic with a lot of social ramifications. The statement in the absrract that among people with mild cognitive impairment, the biomarker profile had a 100% sensitivity for development of AD needs to be carefully considered. First, the metric that is of greater interest is the positive predictive value. Second, it is known that some patients who have the classic AD findings at autopsy did not have mental impairment in life. We know this from the Nun study.

"WHAT TO DO WHEN A PATIENT LACKS CAPACITY - The degree and urgency with which to act on findings of impaired capacity depends on multiple factors, including the expected duration of impairment, the severity of the impairment, and the seriousness of the decision. Unless the urgency of a patient's medical condition requires that a substituted decision be made immediately, efforts should be made to identify and correct any reversible causes of the impairment [26]. This is particularly relevant in hospitalized patients with impaired capacity due to delirium. Treatment of the underlying causes of delirium may restore decision-making capacity. Patients with mild to moderate cognitive impairment that is not expected to fluctuate may benefit from more intensive efforts at education to improve understanding of the relevant facts, followed by reassessment of decision-making abilities. A randomized trial found that a memory and organizational aid given to patients with mild stage Alzheimer disease dementia (n = 80) improved performance on understanding, which in turn increased the likelihood of being judged capable of providing informed consent to enroll in a clinical trial [34]. This enhancement was also effective in a randomized trial with middle-aged and older adults with schizophrenia [35]. For patients whose impairments are severe enough that they are judged to lack the capacity to make a decision, there is a clear ethical obligation to seek out a substitute decision maker. Substitute or surrogate decision makers should ideally have been chosen by the patient in advance. In the absence of a designated surrogate, laws may vary in terms of which people can serve in this proxy role and their hierarchy; in general, the order is the spouse, adult children, parents, siblings, and other relatives. (See "Legal aspects in palliative and end of life care", section on 'Surrogate decision makers'.) When making a substituted decision, the proxy should take into consideration

""I Remember Better When I Paint", narrated by Olivia de Havilland, is the first international documentary about the positive impact of art and other creative therapies on people with Alzheimer's and how these approaches can change the way we look at the disease. A film by Eric Ellena and Berna Huebner, presented by French Connection Films and the Hilgos Foundation. Among those who are featured are noted doctors and Yasmin Aga Khan, president of Alzheimer's Disease International and daughter of Rita Hayworth, who had Alzheimer's."